Pleasenotethatcv Scannotbeaccepted

Title: / Day/WorkTelephone:
Firstname(s): / E-Mailaddress:
Lastname: / Dateofbirth:
Formername(s): / NINumber:
Homeaddress:
Postcode: / Detailsofpersontocontactinanemergency
NameAddress:
Postcode:
HomeTelephone: / EmergencyTelephone:
Jobtitle: / OFFICE
Applicationno:USEONLY
DoyoucurrentlyworkforSandwell
MetropolitanBoroughCouncil?YesNo
AreyouontheAtRiskRegisterfor
SandwellCouncil,SandwellLeisureTrust
orSandwellHomes?YesNo
Referenceno:
Closingdate:

CONFIDENTIAL

SchoolNon-TeachingApplicationForm

PleasenotethatCV’scannotbeaccepted

PleasecompleteALLSectionsofthisformasappropriate,

andforeaseofphotocopying,completeinTypeorBlackInk.

Pleasenotesections1,23ofthisapplicationformwillberemovedpriortoshortlisting.

Returnthecompletedformto:

IfyouareapplyingforaSocialCarepost,areyou

registeredwiththeGeneralSocialCareCouncil(GSCC)? Yes No

IfYES,whatisyourGSCCRegistrationno:

Section2:EqualOpportunities

Aspartofourequalopportunitiespolicywerequestthatyoucompletethefollowing

information.Thisinformationisusedformonitoringpurposesonly.Allinformationwill

betreatedasconfidentialandwillnotbeusedwhenshortlistingordecidingonwhether

anapplicantissuccessfulorunsuccessfulinobtainingemployment.Theinformation

youprovidewillhelpustoensurethatourrecruitmentproceduresarefairbyallowing

ustoidentifyandeliminatepotentialareasofdiscrimination.

EthnicOrigin

Prefernottosay

AsianorAsianBritish-Bangladeshi

AsianorAsianBritish-Indian

AsianorAsianBritish-Pakistani

BlackorBlackBritish-Caribbean

MixedEthnic-WhiteAsian

MixedEthnic-WhiteBlackCaribbean

OtherEthnicGroup-Arab

White-Irish

White-Welsh/English/Scottish/N.Ireland

OtherEthnicGroup/comments

Religion/Belief

Buddhist

Hindu

Muslim

Other

Anyotherethnicgroup(notlisted)

AsianorAsianBritish-Chinese

AsianorAsianBritish-Other

BlackorBlackBritish-African

BlackorBlackBritish-Other

MixedEthnic-WhiteBlackAfrican

MixedEthnicGroup-Other

White-GypsyorIrishTraveller

White-Other

Christian

Jewish

None

Prefernottosay

Sikh

Disability

TheEqualityAct(2010)definesadisabledpersonassomeonewithaphysicalormental

impairmentwhichhasasubstantialandlong-termadverseeffectonhis/herabilitytocarryout

normalday-to-dayactivities.

Doyouconsideryourselftohavesuchadisability?

YesNo

DisabilityCategory

HearingImpairment

LearningDisability

Learningdifficulties

MentalHealthCondition

continuedonPage3

Neurologicalcondition

Physicalco-ordinationdifficulties

Reducedphysicalcapacity

Speechimpairment

Prefernottosay

Visualimpairment(notcorrectby

Mobilityimpairment

Other

Physicalimpairment

Sensoryimpairment

None

Long-standingillnessorhealthcondition

spectaclesorcontactlenses)

Pleaseidentifyanyspecialrequirements,adjustmentsorequipmentwhichmayassistyou

(a)intherecruitmentprocess______

(b)toenableyoutocarryoutthejob______

Gender

Female

Prefernottosay

AgeRange

16-17

25-29

40-49

60-64

SexualOrientation

Bisexual

Heterosexual/straight

Male

18-24

30-39

50-59

65+

Gayman

Prefernottosay

Lesbian/Gaywoman

Tothebestofyourknowledge,areyourelatedtoanyCouncilMemberand/ortoany

employeeofSandwellMetropolitanBoroughCouncil?Ifso,pleaseexplain:______

______

DoyouhavealegalrighttoliveandworkintheUK? Yes No

Ideclarethat,tothebestofmyknowledgeandbelief,theinformationIhaveprovidedistrue.

Iunderstandthatanyfalseinformationorfailuretodiscloseanycriminalconvictionswill

result,intheeventofemployment,inadisciplinaryinvestigation,andmayresultindismissal.

SignedDate

PLEASENOTESECTIONS12OFTHISAPPLICATIONFORMWILLBEREMOVEDPRIORTOSHORTLISTING

Thispageisdeliberatelyleftblank.

Date / College/University
(NameAddress) / ExaminationResults
(Subject,LevelandGrade)
From
Mth/Yr / To
Mth/Yr
Date / College/University/TrainingProvider
(NameAddress) / CourseTitle/Results
From
Mth/Yr / To
Mth/Yr
Date / School/College/University
(NameAddress) / ExaminationResults
(Subject,LevelandGrade)
From
Mth/Yr / To
Mth/Yr

Jobtitle:

Applicationno:

OFFICE

USEONLY

Referenceno:

Section3:Education,TrainingQualifications

Otherqualifications,membershipofprofessionalbodies

Currentjob/posttitle:
Nameaddressofemployer:
Postcode:
Salary/wage:Grade/scale:
Howlonghaveyouworked/
didyouworkthere? / From:To:
Pleasestatenumberofyears:
Doyoustillworkthere: / Yes / No
IfYES,periodofnoticerequired?
IfNO,reasonforleaving
Brieflydescribeyourduties:

Section4:Experience

Pleasecompletethefollowing,startingwithyourcurrentemploymentandincludeall

employment.Anyemploymentwithtemporaryworkagenciesmustshowtheagencyas

theemployeraswellasthebusinesswheretheworkwascarriedout.Pleasealso

includeanybreaksinemploymenthistorytogetherwiththereasonforthebreak.Please

completethefollowingaccuratelyandincludeallexperiencesincetheageof16,or

Date / Employersnameaddress
oryouractivityifyouare/were
notemployed / Positionheld / Reasonfor
leaving/breakin
employment
From
Mth/Yr / To
Mth/Yr

PleasecontinueonaseparatesheetifnecessaryandattachitwithONEstapleinthetopleft-handcornerof

thepage.

Section5:SupportingInformation

Pleaseusethispagetooutlineanyotherinformationthatmayhelpyourapplication.

Continueonaseparatepageifnecessaryandattachitwithonestapleinthetopleft-

handcorner.

PleasecontinueonaseparatesheetifnecessaryandattachitwithONEstapleinthetopleft-handcornerof

thepage.

Name: / Name:
Address:
Postcode: / Address:
Postcode:
Telephoneno: / Telephoneno:
E-Mailaddress: / E-Mailaddress:
Occupation: / Occupation:
Date / TypeofOffence / Sentence/FineImposed / Comments

Section6:Convictions

RehabilitationofOffendersAct1974(exceptions)Order1975

Ifyouhavebeenconvictedofanyoffence(s),orifthereareanyproceedingspending

againstyou,pleasegivedetails.

IfthePersonnelSpecificationadvisesyouthataCriminalRecordsBureaucheckwillbe

required,thepostyouareapplyingforiscoveredbytheRehabilitationofOffendersAct

1974(exceptions)Order1975.Thismeansthatyoumustdeclareallconvictions,including

cautions,reprimandsandformalwarningsforanyoffence(s)whichforotherpurposesare

‘spent’undertheprovisionsoftheAct.

Failuretodiscloseanypreviousconvictions(includingcautions)reprimandsandformal

warningscouldresultindismissalshoulditbesubsequentlydiscovered.Anyinformationgiven,

eitherwhenreturningthisapplicationformorataninterviewwillbeentirelyconfidentialand

willbeconsideredonlyinrelationtothisapplication.

Section 7: References

IfyouhavepreviouslybeenemployedbySandwellCouncil,theunitinwhichyouworkedwill

beaskedtoconfirmdetailsofyouremployment,includingthereasonforyourleaving.

Maywecontactyourcurrentemployerat

thisstagewithoutfurtherreferencetoyou?YesNo

JobCentre / Fish4JobsWebsite
LocalNewspaper / RegionalWebsitewmjobs.co.uk
NationalNewspaper / FromFriendorColleague
SpecialisedPublication / Sandwell’sJobsOpportunityBulletin
Sandwell’sJobsWebsite / Other,pleasespecify
Monster’sJobsWebsite

Section8:DataProtectionAct

TheinformationyouareprovidingwillbeusedbySandwellMetropolitanBoroughCouncilin

connectionwithyourapplicationandforassessingyoursuitabilityforthepostadvertised.The

informationwillbesharedonlyincompliancewiththelawandforthepurposeofmonitoring

theCouncil’spracticestoensureequalityofopportunity.

IfIamappointedtoworkwithSandwellMBC,Igivemypermissionformynameandcontact

detailstobeprovidedtotherecognisedTradeUnionsinSandwell(pleasetickasapplicable).

YesNo

Section9:Howdidyoufindoutaboutthisvacancy?

Pleaseindicatewhereyoufirstsawinformationaboutthisvacancy.

N.B.Canvassingforthisappointmentwilldisqualifyyourapplication.

Pleasecheckthatallsectionsofthisformhavebeencompletedandandifreturningby

post,thatyouhavesignedthedeclarationonthebottomonpage3.Ifyoue-mailthis

formyouwillbeaskedtosigntheformifyouareinterviewed.

P.18/SchoolsRev.04.11

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